HC463 Third Party Reimburse & Risk Mgt

for U1B 2007

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Vision Statement: Park University will be a renowned international leader in providing innovative educational opportunities for learners within the global society.


HC 463 Third Party Reimbursement and Risk Management


U1B 2007 BL


Sims, Phillip L.


Adjunct Faculty



Other Phone





Semester Dates

28 May through 21 July 2007

Class Days


Class Time

5:00 - 7:30 PM

Credit Hours



Principles of Risk Management and Insurance, 10th Edition, G. Rejda, Addison-Wesley Publications, 2004

Additional Resources:

McAfee Memorial Library - Online information, links, electronic databases and the Online catalog. Contact the library for further assistance via email or at 800-270-4347.
Career Counseling - The Career Development Center (CDC) provides services for all stages of career development.  The mission of the CDC is to provide the career planning tools to ensure a lifetime of career success.
Park Helpdesk - If you have forgotten your OPEN ID or Password, or need assistance with your PirateMail account, please email helpdesk@park.edu or call 800-927-3024
Resources for Current Students - A great place to look for all kinds of information http://www.park.edu/Current/.

Course Description:
Public and private insurance, case management, preferred provider organizations, health maintenance organizations, and other forms of third party payment for health care services. Loss prevention for the health care organization through risk management and cost containment. 3:0:3

Educational Philosophy:

Lecture, discussion, overheads. At the end of each chapter key concepts and terms, review questions, application questions, and internet resources to review for possible sources for the students required research paper. These are all text offerings that will be used to aid the student in understanding the objectives of the course.

A research paper will be required of all students. The paper will be at least seven (7) pages long, not including the index (table of contents) and bibliography, typed and double spaced. The paper will deal with a subject in relation to the course and agreed upon between the student and the instructor.


Paper presentation. Each student will prepare a 3 to 5 minute oral presentation that will provide an overview of the paper the student researched on a subject dealing with health insurance or risk management. These research papers will be presented during class with specific dates and times to be discussed in class.

Learning Outcomes:
  Core Learning Outcomes

  1. Describe the various forms of third party payment mechanisms for health care services.
  2. Define the various types of risk exposure that health care providers are confronted with in today's real world environment.
  3. Differentiate between the various third party payers and identify the most important aspects of each different payer's payment process.
  4. Formulate basic corrective or preventive measures for the various types of risk exposure health care providers must deal with on a day-to-day basis.
  5. Evaluate the loss prevention measures utilized by health care providers.
  6. Select the most appropriate payment methodology for a health care institution's services to ensure the maximum financial benefit to that institution.
  7. Determine the appropriate cost containment measures to be used by a health care provider.
  8. Recommend an appropriate operational response for the common compliance issues faced by health care providers in today's regulatory environment.

  Instructor Learning Outcomes
  1. Understanding Risk Management and Risk Exposure
  2. Understanding the different types of insurance
  3. Ability to analyze insurance contracts
  4. Understand the legal and regulatory considerations of insurance
Core Assessment:

Class Assessment:
Examinations, research paper, in class paper presentation.


Each test 100 points, 2 tests( mid-term and final). Research paper 100 points. Presentation of research paper 100 points. 90 to 100       A
80 to 89         B
70 to 79         C
60 to 69         D
Below 60        F


All final exams will be comprehensive and will be closed book and closed notes.  If calculators are allowed, they will not be multifunctional electronic devices that include features such as: phones, cameras, instant messaging, pagers, and so forth.  Electronic Computers will not be allowed on final exams unless an exception is made by the Associate Dean.

Late Submission of Course Materials:

 The research paper must be typewritten and submitted at the last lecture prior to the

  final examination (7-11) unless previously coordinated with the instructor. Late

  papers will not be accepted and will be marked down on letter grade.

Classroom Rules of Conduct:


         Students are expected to come to all classes and be on time. Roll will be checked at

         each class meeting. Classes missed for legitimate reasons, such as illness,

         temporary duty, are excusable; however, the student must make up the missed

         work. The student is responsible for providing the instructor with justification for an

         excused absence either prior to or immediately after the absence. Two unexcused

         absences are excessive and three unexcused absences will result in an involuntary

         withdrawal and a grade of “F” (attendance) for the course.

Course Topic/Dates/Assignments:

5-28 Administrative announcements, discussion of the syllabus, lecture/discussion on

history and types of health insurance. Chapters 1 & 2. Risk in our society. Insurance and risk.

5-30 Discuss Chapter 3. Introduction to risk management.

6-4 Discuss Chapters 4 and 5. Advanced topics in risk management. Types of Insurers

and Marketing Systems.

6-6 Discuss Chapters 6 and 7. Insurance Company Operations. Financial Operations of


6-11 Discuss Chapters 8 and 9. Government Regulation of Insurance. Fundamental

Legal Principles.

6-13 Discuss Chapters 10, 11 and 12. Analysis of Insurance Contracts. Life Insurance.

Life Insurance Contractual Provisions.

6-18 Discuss Chapters 13 and 14. Buying Life Insurance. Annuities and Individual

Retirement Accounts. Review for the mid-term examination.

6-20 Mid-term examination, chapters 1 through 14.

6-25 Discuss Chapters 15 and 16. Individual Health Insurance Coverages. Employee

Benefits: Group Life and Health Insurance.

6-27 Discuss Chapters 17 and 18. Employee Benefits: Retirement Plans. Social

Insurance. Student presentations.

7-2 Discuss Chapters 19, 20, and 21. The Liability Risk. Home Owners Insurance

Sections I and II. Student presentations.

7-4 Discuss Chapters 22 and 23. Auto Insurance. Auto Insurance and Society. Student


7-9 Discuss Chapters 24 and 25. Other Property and Liability Insurance Coverages

Commercial Property Insurance. Student presentations.

7-11 Discuss Chapters 26 and 27. Commercial Liability Insurance. Crime

Insurance and Surety Bonds. Student presentations. Review for the final


7-16 Final examination. Chapters 15 through 27.

7-18 Review of the final examination. Make-up student presentations.

Academic Honesty:
Academic integrity is the foundation of the academic community. Because each student has the primary responsibility for being academically honest, students are advised to read and understand all sections of this policy relating to standards of conduct and academic life.   Park University 2006-2007 Undergraduate Catalog Page 87-89

Plagiarism involves the use of quotations without quotation marks, the use of quotations without indication of the source, the use of another's idea without acknowledging the source, the submission of a paper, laboratory report, project, or class assignment (any portion of such) prepared by another person, or incorrect paraphrasing. Park University 2006-2007 Undergraduate Catalog Page 87

Attendance Policy:
Instructors are required to maintain attendance records and to report absences via the online attendance reporting system.

  1. The instructor may excuse absences for valid reasons, but missed work must be made up within the semester/term of enrollment.
  2. Work missed through unexcused absences must also be made up within the semester/term of enrollment, but unexcused absences may carry further penalties.
  3. In the event of two consecutive weeks of unexcused absences in a semester/term of enrollment, the student will be administratively withdrawn, resulting in a grade of "W".
  4. A "Contract for Incomplete" will not be issued to a student who has unexcused or excessive absences recorded for a course.
  5. Students receiving Military Tuition Assistance or Veterans Administration educational benefits must not exceed three unexcused absences in the semester/term of enrollment. Excessive absences will be reported to the appropriate agency and may result in a monetary penalty to the student.
  6. Report of a "F" grade (attendance or academic) resulting from excessive absence for those students who are receiving financial assistance from agencies not mentioned in item 5 above will be reported to the appropriate agency.

Park University 2006-2007 Undergraduate Catalog Page 89-90

Disability Guidelines:
Park University is committed to meeting the needs of all students that meet the criteria for special assistance. These guidelines are designed to supply directions to students concerning the information necessary to accomplish this goal. It is Park University's policy to comply fully with federal and state law, including Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, regarding students with disabilities. In the case of any inconsistency between these guidelines and federal and/or state law, the provisions of the law will apply. Additional information concerning Park University's policies and procedures related to disability can be found on the Park University web page: http://www.park.edu/disability .


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Last Updated:5/9/2007 7:02:59 PM